Citations 2
Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study
Rostami, Kamran , Ensarı, Arzu , Marsh, Michael N. , Villanacci, Vincenzo , Aghdaei, Hamid Asadzadeh , Bai, Julio C. , Bassotti, Gabrio , Becheanu, Gabriel , Bell, Phoenix , Bella, Camillo Di, Bozzola, Anna, Cadei, Moris, Casella, Giovanni , Ciacci, Carolina , Ciobanu, Delia , Danciu, Mihai , Das, Prasenjit , Drage, Michael G. , Elli, Luca , Fasano, Alessio , Florena, Ada Maria , Fusco, Nicola , Guandalini, Stefano , Hayman, David T. S. , Ishaq, Sauid , Jericho, Hilary , Johncilla, Melanie , Johnson, Matt, Kaukinen, Katri , Levene, Adam, Liptrot, Sarah, Lu, Laura , Makharia, Govind , Mathews, Sherly, Mazzarella, Giuseppe , Maxim, Roxana, Myint, Khun La Win, Shalmani, Hamid Mohaghegh , Moradi, Afshin , Mulder, Chris J. , Ray, Ronnie, Ricci, Chiara , Rostami‐Nejad, Mohammad , Sapone, Anna, Sanders, David S. , Taavela, Juha , Volta, Umberto , Walker, Marjorie M. , Carroccio, Antonio , Asadzadeh Aghdaei, Hamid , Bassotti, Gabrio , Bell, Phoenix , Casella, Giovanni , Ciacci, Carolina , Apostol Ciobanu, Delia Gabriela , Danciu, Mihai , Das, Prasenjit , Elli, Luca , Fasano, Alessio , Fusco, Nicola , Guandalini, Stefano , Hagen, Catherine E. , Hayman, David T S , Makharia, Govind K , Mazzarella, Giuseppe , Mohaghegh-Shalmani, Hamid , Ricci, Chiara , Rostami-Nejad, Mohammad , Taavela, Juha , Volta, Umberto , Walker, Marjorie , Drage, Michael G , Srivastava, Amitabh , Catassi, Carlo , Cross, Simon S. , SORDO, Rachele DEL , Going, James J. , Derakhshan, Mohammad Hossein
Nutrients | June 16, 2022 | Volume: 14 | Issue: 12 | Pages: 2487
Background: Histological changes induced by gluten in the duodenal mucosa of patients with non-coeliac gluten sensitivity (NCGS) are poorly defined. Objectives: To evaluate the structural and inflammatory features of NCGS compared to controls and coeliac disease (CeD) with milder enteropathy (Marsh I-II). Methods: Well-oriented biopsies of 262 control cases with normal gastroscopy and histologic findings, 261 CeD, and 175 NCGS biopsies from 9 contributing countries were examined. Villus height (VH, in μm), crypt depth (CrD, in μm), villus-to-crypt ratios (VCR), IELs (intraepithelial lymphocytes/100 enterocytes), and other relevant histological, serologic, and demographic parameters were quantified. Results: The median VH in NCGS was significantly shorter (600, IQR: 400–705) than controls (900, IQR: 667–1112) (p < 0.001). NCGS patients with Marsh I-II had similar VH and VCR to CeD [465 µm (IQR: 390–620) vs. 427 µm (IQR: 348–569, p = 0·176)]. The VCR in NCGS with Marsh 0 was lower than controls (p < 0.001). The median IEL in NCGS with Marsh 0 was higher than controls (23.0 vs. 13.7, p < 0.001). To distinguish Marsh 0 NCGS from controls, an IEL cut-off of 14 showed 79% sensitivity and 55% specificity. IEL densities in Marsh I-II NCGS and CeD groups were similar. Conclusion: NCGS duodenal mucosa exhibits distinctive changes consistent with an intestinal response to luminal antigens, even at the Marsh 0 stage of villus architecture.
Nomenclature and diagnosis of seronegative coeliac disease and chronic non-coeliac enteropathies in adults: the Paris consensus
Schiepatti, Annalisa , Sanders, David S. , Baiardi, Paola , Caio, Giacomo , Ciacci, Carolina , Kaukinen, Katri , Lebwohl, Benjamin , Leffler, Daniel A. , Murray, Joseph A. , Rostami, Kamran , Volta, Umberto , Biagi, Federico , Malamut, Georgia , Murray, J A , Ciacci, Carolina , Malamut, Georgia , Rubio‐Tapia, Alberto
Gut | June 8, 2022 | Volume: 71 | Issue: 11 | Pages: 2218-2225
Objective Differential diagnosis of villous atrophy (VA) without coeliac antibodies in adults includes seronegative coeliac disease (CD) and chronic enteropathies unrelated to gluten, ie. non-coeliac enteropathies (NCEs). There is currently no international consensus on the nomenclature and diagnostic criteria for these enteropathies. In this work, a Delphi process was conducted to address this diagnostic and clinical uncertainty. Design An international task force of 13 gastroenterologists from six countries was recruited at the 16th International Coeliac Disease Symposium, Paris, 2019. Between September 2019 and July 2021, a Delphi process was conducted through mail surveys to reach a consensus on which conditions to consider in the differential diagnosis of VA with negative coeliac serology and the clinical diagnostic approaches required for these conditions. A 70% agreement threshold was adopted. Results Chronic enteropathies characterised by VA and negative coeliac serology can be attributed to two main clinical scenarios: forms of CD presenting with negative serology, which also include seronegative CD and CD associated with IgA deficiency, and NCEs, with the latter recognising different underlying aetiologies. A consensus was reached on the diagnostic criteria for NCEs assisting clinicians in differentiating NCEs from seronegative CD. Although in adults seronegative CD is the most common aetiology in patients with VA and negative serology, discriminating between seronegative CD and NCEs is key to avoid unnecessary lifelong gluten-free diet, treat disease-specific morbidity and contrast poor long-term outcomes. Conclusion This paper describes the Paris consensus on the definitions and diagnostic criteria for seronegative CD and chronic NCEs in adults.